SaHF DMBC Volume 1 Edition 1.1.pdf - Shaping a healthier future

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Planned investment 2013/14–17/18 (£m) 8e. Delivering out of hospital care 8.19. Investment in out of hospital services Across the care system, we will be investing in specific services to make these changes a reality. As the way in which services are delivered in NW London are changed over the next five years, investments in out of hospital services will result in more staff and better facilities to deliver it. These investments have been developed based on modelling of the changes to investment associated with Shaping a healthier future over three years. As the programme will be delivered over five years, these have then been extended by two further years to provide estimates across the life of the programme. This work suggests that in five years, we will be spending £190 million more a year on out of hospital services. In this time, we also expect to invest £81–229 million in our estate to ensure we have the buildings we need to provide services. This investment in primary and community care will result in greater capacity within out of hospital settings, thereby reducing the burden on hospital care. This level of investment in out of hospital will be required regardless of acute reconfiguration. Figure 8.26 summarises the initial plans for investment in out of hospital services. Detail on the implications of this investment for our workforce can be found in Chapter 16. Figure 8.26: Planned investment in out of hospital services across NW London (2013/14– 17/18) 7 Capital Revenue 250 200 150 £229m £190m 100 £112m 50 0 £43m £6m £74m £32m £81m Local hospitals Hubs Primary care estate Total capital Out of hospital services Capital (max) Capital (min) Revenue The investment identified in the figures above is indicative, based on CCG strategic plans. Specific investments will need to be agreed through the normal planning and governance 7 £43m is gross and excludes land sales. £190m is the additional recurrent revenue investment in out of hospital services. It will build up to this level over five years so that by 2017/18, we will be spending an additional £190 million annually on out of hospital services. 8e. Delivering out of hospital care 258
processes of the CCG and as such the production and agreement of robust business cases demonstrating both value for money and affordability to the CCG. We therefore intend to undertake further work if the recommendation is agreed to design the new clinical models that would support the mix of services on the local hospital site, including: Engaging further with acute, mental health and community providers further on the benefits of moving services to local hospitals Examining productivity improvements that could be made by adopting different service models Confirming the mix, number and volume of services that best meet patients‟ needs on the local hospital sites. This further work would be used to develop outline business cases for each site verifying the mix of clinically appropriate and financially affordable services. Chapter 16 provides a more detailed view of capital investment and affordability. 8.20. Progress across NW London Across NW London, three key initiatives have supported all eight CCGs to begin to deliver out of hospital services in line with their strategies. These are the development of urgent care centres (see Chapter 8d), the deployment of 111 and integrated care. In addition, all the CCGs have, in their commissioning intentions for 2013/14, planned for a range of new services that will deliver major parts of their out of hospital strategies (see Appendix L). These services enable the CCGs to deliver the vision articulated in their out of hospital strategies, and will be a key enabler of the recommendation for Shaping a healthier future. For further information on the implementation of the CCG strategies, please see Chapter 16. 8.20.1. 111 111 services are part of each CCG‟s out of hospital strategy. The aim of the 111 service is to provide people with an alternative to dialling 999 when they don‟t believe that there condition is an emergency. The 111 service takes callers through NHS Pathways which determines where the patient should be seen and how quickly. Across NW London a comprehensive Directory of Service has been developed to support the 111 service; the Directory of Service tells the call handler which services are locally available to them. Hillingdon, Hammersmith & Fulham, Central London and West London CCGs were all early pilot sites for the 111 service and went live in early 2012. Brent, Ealing, Harrow and Hounslow CCGs plan to go live in late February 2013. The most recently available data is for December showing that in Hillingdon, 111 answered 5,568 calls. Of these calls: 96% calls were answered within 60 seconds exceeding the national standard of 80% There was a 15% ambulance dispatch rate. 17% of calls were referred to Clinical Advisor. In London the range of calls referred was between 16 and 32%. The most recently available data for Hammersmith & Fulham, Central London and West London CCGs shows that 6,461 calls were answered in December. Of these calls: 8e. Delivering out of hospital care 259
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North West London Shaping a healthi
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Table of contents Volume 1 Foreword
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Foreword Dr Mark Spencer The Clinic
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6. Consultation, feedback and how w
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13. Equalities implications This ch
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1. Executive Summary Introduction t
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The overall programme timeline is b
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The process was used before consult
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• Delivery of multi-disciplinary
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Stage 1 - Case for Change Our work
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For Quality of care, clinicians hav
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1 2 3 4 5 A 6 B 7 C 8 Quality of Ca
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Assuring the proposals Throughout t
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Programme implementation arrangemen
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5. To agree that Hammersmith Hospit
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DMBC Chapter 2 - Introduction to th
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2. Introduction to the NHS in NW Lo
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Figure 2.3: Clinical Commissioning
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West Middlesex University Hospital
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major hospital, elective centre and
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DMBC Chapter 3 - Introduction to th
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3. Introduction to the Shaping a he
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3.3 Programme governance The Joint
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The JCPCT is advised by a Programme
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Consultation - during this phase, t
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Ensure consistency of communication
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Stakeholder Group Political Individ
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o o o o o Rationale for options dev
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The implications of the options in
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DMBC Chapter 4 -The Case for Change
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4. The Case for Change This chapter
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Stroke Services: The provision of s
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We need to do more to support patie
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In NW London, however, the NHS is s
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Figure 4.6: Emergency general surgi
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attack or stroke to designated cent
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Figure 4.9: Evaluation of primary c
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Inequalities would continue and pro
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DMBC Chapter 5 - Process for identi
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5. Process for identifying a recomm
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Figure 5.1: Basis of decision of wh
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We confirmed this decision, and the
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5.5 A detailed description of the s
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Correct care setting to deliver hig
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Figure 5.11: Ratings used in evalua
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DMBC Chapter 6 - Consultation, feed
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6. Consultation, feedback and how w
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6.2.1 Key findings from the consult
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times (particularly for patients tr
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Westminster City Council, Adult Ser
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Analysed and considered consultatio
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6.3 Our responses to feedback This
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Feedback received Stakeholders who
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6.3.3 Theme 3: Clinical vision and
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6.3.5 Theme 5: Proposals for local
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DMBC Chapter 7 - Clinical vision, s
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7a. Clinical, vision, standards and
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Local clinicians agreed that in ord
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▪ Expectant mothers should have t
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# Standard care services (111). As
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Figure 7.8: Development of the acut
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# Standard Adapted from source depa
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Figure 7.11: Shaping a healthier fu
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No. Standard Adapted from source Su
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No. Standard Adapted from source se
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# Standard All emergency department
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# Standard All non-urgent - within
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Figure 7.18: Shaping a healthier fu
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# Standard Adapted from source shou
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# Standard Adapted from source Comm
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The final standards are more demand
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Figure 7.26: Proposed services to b
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Each CCG is taking steps to help pr
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in major hospitals) and equipment t
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tangible differences for patients
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Referral A&E Illustrative patient j
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Illustrative patient journey matern
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Illustrative patient journey in mat
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Illustrative patient journey planne
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GP-led care Illustrative patient jo
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7.8.1 Scope of the CIG’s work The
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Theme Clinical outcomes Staff attit
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Further stakeholder engagement is n
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Figure 7.31 E&UC CIG Responses to N
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NCAT recommendation CIG response Se
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Conditions suitable for UCC Clinica
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Exclusion criterion Mental health A
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Diagnostics 7.14.3 Streaming, regis
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Biochemistry Microbiology Radiology
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The Provider must deliver appropria
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Figure 7.41: E&UC CIG recommended k
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will be able to establish a service
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The UCC provider will be responsibl
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Key differences Governance As with
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should be provided with appropriate
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Process map 1: Assessing UCC patien
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Process map 3: UCC to ED transfer p
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make an appointment with their own
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7.19 ED workforce A programme-wide
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The purpose of this section is to s
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Figure 7.45 Consultation results on
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Figure 7.46: Specific Responses the
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NCAT recommendation Original Progra
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7.25.1 London Health Programmes cli
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Future capacity in centralised serv
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3. There would be an additional "st
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in NWL will have a choice of delive
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Support for the proposal is higher
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Figure 7.49: Specific feedback the
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Sub-Theme Organisation Support Conc
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Sub-Theme Organisation Support Conc
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7.36.1 National Clinical Advisory T
Page 237 and 238: NCAT recommendation Further engagem
Page 239 and 240: edistributed nationwide. We envisag
Page 241 and 242: 6. The Maternity CIG have considere
Page 243 and 244: DMBC Chapter 8A-E - Out of hospital
Page 245 and 246: Out of hospital improvements This c
Page 247 and 248: 8.2. Settings of out of hospital ca
Page 249 and 250: practical solution for the site, wh
Page 251 and 252: Brent Health Partnerships Overview
Page 253 and 254: Consultation theme Standards for ca
Page 255 and 256: Consultation theme Integration Inve
Page 257 and 258: 8.5.3. Workforce Following feedback
Page 259 and 260: Delivering this workforce shift wil
Page 261 and 262: Measure type Domain Potential measu
Page 263 and 264: 8b. Primary care development 8.6. S
Page 265 and 266: consultation they could have receiv
Page 267 and 268: 8.10. Next steps We are developing
Page 269 and 270: Figure 8.11: Hub/health centre requ
Page 271 and 272: some cases, these will be offered o
Page 273 and 274: Process for development of local ho
Page 275 and 276: The result is an emerging picture o
Page 277 and 278: Across NW London, these sites will
Page 279 and 280: need redeveloping or rebuilding to
Page 281 and 282: 8d. Urgent care centres When indivi
Page 283 and 284: Figure 8.22: NW London urgent care
Page 285 and 286: Conditions suitable for UCC Clinica
Page 287: Key differences Governance As with
Page 291 and 292: around the table accelerates the un
Page 293 and 294: Improved empowerment - specifically
Page 295 and 296: Figure 8.28: Realising our integrat
Page 297 and 298: Figure 8.29: Summary of CCG commiss
Page 299 and 300: DMBC Chapter 9 - Decision making an
Page 301 and 302: 9a. Decision making analysis stages
Page 303 and 304: Correct care setting to deliver hig
Page 305 and 306: “The Brent Health Partnerships Ov
Page 309 and 310: Royal College of Midwives “The RC
Page 313 and 314: clinicians wanted to take this into
Page 315 and 316: 9.6.3 Feedback received about the s
Page 317 and 318: Confirm the service models reflect
Page 319 and 320: Figure 9.9: The seven hurdle criter
Page 321 and 322: surgeons in NW London, but we would
Page 323 and 324: We confirmed this decision with the
Page 325 and 326: Appropriate staffing is integral to
Page 327 and 328: The proposals are supported by Depa
Page 329 and 330: NW London to deliver high quality c
Page 331 and 332: 1. Support predicting where activit
Page 333 and 334: Figure 9.15: Example travel time ma
Page 335 and 336: The analysis shown in Figure 9.18,
Page 337 and 338: Figure 9.18: Impact on private car
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33% support 10% opposed 57% of peop
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Figure 9.21: Watershed map for blue
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etained as a major hospital, becaus
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9.7.29 The implications of this fee
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Figure 9.25: Potential activity flo
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Figure 9.27: Changes in travel time
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Figure 9.29: Changes in travel time
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Figure 9.31: Possible choices betwe
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Either Charing Cross or Chelsea & W
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Figure 9.33: Option A, excluding ca
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Figure 9.36: Option C responses, in
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Richmond Upon Thames LINk Royal Bor
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Southall Black Sisters “The closu
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Figure 9.38: Ranking of evaluation
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Figure 9.42: Evaluation criteria as
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anked third according to the mean s
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9.9.5 The analysis of the five eval
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Figure 9.45: Quality Dashboard data
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Response to feedback about the eval
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Figure 9.48: Quality of care - Acut
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experience. In order to use this as
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Figure 9.50: Time to major hospital
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Rationalising provision across the
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Figure 9.51: Blue light travel time
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Figure 9.52 shows the reduction in
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3 Value for money 9.9.26 The purpos
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Staff recommendation as a place to
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This analysis was agreed prior to c
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Figure 9.56: Ease of delivering eac
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Response to feedback about implemen
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Changes to the designation of the M
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5 Research and Education: Disruptio
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Figure 9.60: Evaluation of disrupti
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9.9.48 The outcome of the disruptio
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Greg Hands, MP for Chelsea & Fulham
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comprises more than 22 million cita
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Quality/Impact score Figure 9.65 Re
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9. Decision making analysis - stage
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There were six distinct parts of th
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Figure 9.69: 5 year gross savings,
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Figure 9.73: Commissioners intend t
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Figure 9.75: Beds bridge: 2012/13 t
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The key modelling assumptions appli
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Figure 9.79: DMBC NHS net capital e
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Figure 9.81: Approach to estimating
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Figure 9.84: Summary of net surplus
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Figure 9.86: Evaluation of total su
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9.13.9 Impact of the changes: Updat
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Figure 9.89: Effect of the expanded
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Correct care setting to deliver hig
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Sensitivity tests g) Tariff efficie
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Figure 9.93 summarises the impact o
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Figure 9.94: Change in expanded NPV
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The sensitivity analysis supports t
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DMBC Chapter 10 - The recommendatio
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10. The proposed future configurati
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The changes to the scoring before a
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10.3. Why this is the recommendatio
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In the rest of this section, the se
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